AB1083 HALF OF THE PSORIATIC ARTHRITIS PATIENTS IN A GERMAN CLAIMS DATA COHORT EXPERIENCE POLYPHARMACY
Authors: K. Albrecht, A. Regierer, A. Strangfeld, U. Marschall, J. Callhoff
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Psoriatic arthritis (PsA) therapy and comorbidity almost inevitably lead to the issue of polypharmacy (intake of ≥ 5 medications daily), which may further challenge the management of the disease. There is a lack of data on polypharmacy in PsA. <h3>Objectives</h3> To assess polypharmacy in women and men with PsA. <h3>Methods</h3> From the German BARMER health insurance database, 11,984 persons with PsA and DMARD therapy in 2021 were included and compared to sex and age matched controls without inflammatory arthritis. Medications were grouped by Anatomical Therapeutic Chemical groups. Polypharmacy (≥ 5 concomitant drugs) was compared by sex, age and comorbidity using the Rheumatic disease comorbidity index (RDCI, range 0-9) and the Elixhauser comorbidity index (range 0-31). The mean difference in the medication number between persons with PsA and controls was estimated with a linear regression model. <h3>Results</h3> From all adult persons insured in 2021 (n=7.4 Mio.), 190,000 (2.6%) had a diagnosis of psoriasis (ICD-10-GM Code L40). Of those, 20,245 (11%) had a PsA diagnosis (L40.5 + M07.0-3) and 11,984 received any DMARD therapy. A total of 119,840 persons without diagnoses of inflammatory arthritis were included as controls. A total of 63% of all persons with PsA and DMARD therapy were women and the overall mean age was 60 years (Table 1). Polypharmacy was significantly higher in PsA (49%) compared to controls (17%), more frequent in women (52%) compared to men (45%) and strongly increased with age (15% in 18 to 30 yrs., 78% in &gt;80 yrs.) and comorbidity. Comorbidity was more frequent in PsA compared to controls (mean Elixhauser comorbidity score 3.6 vs. 2.2 in controls, table 1). This applies to the conditions of the metabolic syndrome: hypertension (57% vs. 42% in controls), dyslipidemia (32% vs. 27%), diabetes (21% vs. 13%) as well as to all other comorbidities, in particular osteoarthritis (35% vs. 15%) and depression (28% vs. 16%). Compared to controls, all ATC drug classes were significantly more frequent in persons with PsA, most commonly drugs for the musculoskeletal system (81% vs. 30%), immunomodulating agents (56% vs. 2.6%), cardiovasculars (62% vs. 48%), alimentary tract/metabolism (57% vs. 31%) and nervous system (50% vs. 31%) (frequencies for PsA see Figure 1). For each unit increase of the RDCI, the age-adjusted number of medications increased by 0.98 (95% CI 0.95; 1.01) units in men and 0.93 (0.90; 0.96) units in women. Compared to controls, the number of prescribed medications (mean 4.9 (2.8)) was 2.4 (2.34; 2.43) units higher in women and 2.3 (2.21; 2.35) units higher in men. <h3>Conclusion</h3> Polypharmacy is common in PsA and is composed of PsA-specific medication as well as medication for frequent comorbidities, equally affecting women and men. While DMARD therapy is essential to prevent subsequent damage, systemic GC should be avoided in PsA and analgesics might be dispensable if PsA is well controlled. With regard to the elderly, more frequent therapy with bDMARDs should be discussed which may result in reduced use of analgesics, opioids, and other secondary-induced co-medication. <h3>Acknowledgements</h3> The study was supported by the Federal Ministry of Education and Research within the network TARISMA [01EC1902A]. The authors thank the BARMER for providing access to data via their data warehouse for this study. We thank the patient partners in the TARISMA project for dedicating their time to add the patient view to this project. <h3>Disclosure of Interests</h3> Katinka Albrecht: None declared, Anne Regierer Speakers bureau: BMS, Novartis, Pfizer, and Roche, Anja Strangfeld Speakers bureau: AbbVie, Amgen, BMS, Celltrion, Janssen, Lilly, Pfizer, Roche, Sanofi, UCB, Grant/research support from: Non-personal, joint grant from a consortium of 14 pharmaceutical companies for the biologics register RABBIT to my institute, Ursula Marschall Employee of: Employee of the Barmer statutory health insurance., Johanna Callhoff Speakers bureau: Janssen, Grant/research support from: AbbVie, AstraZeneca, BMS, GALAPAGOS, GSK, Lilly, Medac, MSD, Pfizer, Sanofi-Aventis and UCB.